COVID-19 Pandemic: Staged Management of Surgical Services for Gynecology and Obstetrics

Weber Lebrun, Emily E.; Moawad, Nash S.; Rosenberg, Eric I.; Morey, Timothy E.; Davies, Laurie; Collins, William O.; Smulian, John C.

Abstract The COVID-19 pandemic has required an unprecedented global healthcare response requiring maintenance of existing hospital-based services while simultaneously preparing for high-acuity care for infected and sick individuals. Hospitals must protect patients and the diverse healthcare workforce by conserving personal protective equipment and redeployment of facility resources. While each hospital or health system must evaluate their own capabilities and surge capacity, we present principles of management of surgical services during a health emergency and provide specific guidance to help with decision-making. We review the limited evidence from past hospital and community responses to various health emergencies and focus on systematic methods for adjusting surgical services to create capacity, addressing the specific risks of COVID-19. Successful strategies for tiered reduction of surgical cases involve multi-disciplinary engagement of the entire healthcare system and use of a structured risk-assessment categorization scheme which can be applied across the institution. Our institution developed and operationalized this approach over three working days, indicating that immediate implementation is feasible in response to an unforeseen healthcare emergency.